A Physician Fee that Applies to Acute but not to Preventive Care: Evidence from a German Deductible Program

Abstract

A certain German sickness fund offers € 240 per year to its clients if they pay the first € 300 of their health care bills, except for physician visits, for which a flat rate of € 20 applies. This paper studies the effects of this deductible scheme on health care demand by comparing about 5,000 participants with a control sample, using the sickness fund's claims data covering in-patient care, prescription drugs, and ambulatory care. The data extend to three years: the year of the start of the program and the two years preceding this. We apply a parametric approach that models the choice of the deductible program, the probability of positive expenses as well as the demand for health care services, conditional on demand being positive. Instruments for the participation decision are used, and the results are compared with those of an exogenous specification of the program choice. The physician fee appears to significantly decrease the number of visits as well as the expenses for curative care. By contrast, prevention activities, not subject to the co-payment, remain constant.